Sunday, November 04, 2007

How much can a one month stay + treatment +intensive care in a public hospital cost?$41,000. Note that this is probably subsidised class "C" charges since the father of the patient works as a driver. The full charges is $41,000 x 4 = $164,000. If means testing is in force, which will most probably disqualify families who stay in condos (or five room flats?) earning professional or double incomes from class "C"...bills in the region of $100K will be commonplace. Now I see why PM Lee says means testing is to help the poor....because it cannot possibly help the middle class..If you have children, the message is very clear.... you are strongly advised to buy insurance and you have to be prepared to pay more premiums as the cost of healthcare goes up. There is little doubt that the govt is moving towards an American style system based on insurance in which there is little motivation for the govt to rein in the cost as everything has to be covered by insurance and govt subsidies withdrawn/reduced. The Americans have a system that generates the highest profits for healthcare companies in the world - see Michael Moore's move SICKO. Our leaders aspires Singapore to be a highly profitable medical hub for the rich in the region why should precious resources be allocated to people who cannot afford to pay when others are willing to pay for it - it amounts to an opportunity cost & misallocation that Singapore Inc cannot afford. The PAP govt is going to right this wrong for Singapore Inc and as good corporate citizens we have to be prepared to fork out more in insurance premiums. Thank goodness our beloved Straits Times is doing an excellent job to remind us to get insurance packages....some of which are sold by our GLCs.

------------------------------------------------------Nov 4, 2007

40 years of his Medisave wiped out in 3 monthsMr Mohammad did not buy insurance for his children and was forced to break the bank when his daughter came down with ovarian cancerBy Nur Dianah SuhaimiMR MOHAMMAD hopes to get financial aid from SGH to pay his daughter's hospital bill. -- ST PHOTO: NG SOR LUANView more photosDRIVER Mohammad Abdullah had saved over $30,000 in his Medisave account over 40 years - and saw it go in just three months after his daughter got ovarian cancer.The youngest of his four kids, Siti Aishah, 17, was diagnosed last August and has been in the Singapore General Hospital (SGH) ever since..Siti Aishah, like the rest of her siblings, has no health insurance and doctors have no idea how long she will have to stay in hospital. Her surgery, chemotherapy and dialysis sessions, blood transfusions, treatments in the intensive care unit and morphine jabs chalked up a $41,000 hospital bill in just the first month. .Government subsidies and her father's Medisave paid most of that bill but chemotherapy, dialysis and morphine are not subsidised and must be paid for in cash. This took about $4,000.Siti Aishah's final bill is still to come and her father is in a fix. His Medisave is gone, his savings are depleted, his wife - a Malaysian and a housewife - has no CPF or Medisave. His three older children have their own families and financial responsibilities.He thought they didn't need it.'I don't know how I'm going to pay. This is my fault. It never occurred to me to buy my children health insurance. I didn't think they'd fall seriously ill.' MR MOHAMMAD ABDULLAH, whose daughter Siti Aishah was diagnosed with ovarian cancer.They waited too long

Some basic policies Mr Mohammad, 58, earns $2,500 a month. 'I don't know how I'm going to pay,' he said. 'This is my fault. It never occurred to me to buy my children health insurance. I didn't think they'd fall seriously ill.' Last week, it was announced that newborns and young children will be automatically insured by MediShield..Medical social workers applaud this new initiative.The KK Women's and Children's Hospital (KKH), which cares for most sick children here, sees about 30 families seeking financial help each day, with at least 90 per cent of them admitting that they did not buy insurance for their kids.KKH's chief medical social worker Sylvia Mun said: 'We see an entire spectrum of people, from the low- to middle-income.'For low-income families, a three-day ward stay for something as minor as asthma can be a financial disaster.But middle-income families find themselves in a rut when their children are hit by serious, chronic illnesses, said Mrs Mun, who covered her three children under MediShield as soon as they were born.Each week, her team will see at least one family saddled with massive hospital bills, ranging in the hundreds of thousands.'If the family can't qualify for Medifund or other subsidies, we accept instalment payments,' said Mrs Mun.Families can be paying the hospital bills even long after their child has died.Siti Aishah's illness shocked her family. Apart from the occasional cough or cold, the Institute of Technical Education (ITE) student was never seriously ill.Then, three months ago, she started having bad headaches for days. Then came unbearable stomachaches. Her stomach became so bloated that she looked seven months pregnant.For four days, she could barely eat or drink, vomiting often. She was taken to SGH, where she was diagnosed with advanced ovarian cancer. Doctors immediately removed one of her ovaries and a cancerous tumour in her womb but other complications set in. Her kidneys stopped functioning and there were blood clots in her lungs, causing breathing difficulties.After being treated twice in the intensive care unit, her condition improved. She has had 20 sessions of chemotherapy and is slowly regaining strength.Siti Aishah, who is 145cm tall, weighs only 30kg now and has lost almost all of her once-thick locks. She said: 'I know that the past few months have been difficult for my parents. I just want to get well and go home quickly.''Mr Mohammad hopes to get financial help from SGH. 'If I can't get aid, I might just have to pay by instalments.'His predicament is all too familiar to another family whose sick child also racked up massive medical bills..The parents, both teachers, had not insured their two children. The mother, 41, said: 'We were planning to get insurance for the children but always procrastinated.'Her seven-year-old daughter was diagnosed with leukaemia when she was four. The treatment, which included chemotherapy, blood transfusions and steroid shots, lasted eight months, much of it in hospital..The mother said: 'She was admitted to hospital more than 40 times in the first year. My husband and I were living out of our suitcases.'The medical bills came up to $60,000, a quarter of which the parents paid for in cash. The rest came from their Medisave accounts.Because the cancer was detected early, the prognosis was good. The girl recovered quickly and is in remission - and Primary 1.But the family is taking no chances. The mother said: 'After our daughter's illness, we wasted no time buying health insurance for both our children.'ndianah@sph.com.sg

Some comments by readers on the insurance policies we have been sold:

Latest commentsThe impression that an "as charged" plan, together with a deductible & co-insurance rider, will pay off "an entire bill" is an absolute false sense of security.No two plans combined will absolutely cover a hospital bill 100%!Stay alert! Analyse the plan's features and benefits closely.Be prepared to pay the required premium for the highest level of protection.Each "shield" plan has an annual limit of claim.Certain "as charged" plan has pro-ration factors.Pro-ration factor will limit the allowable claim amount.This pro-ration factor usually is included for stays in private hospitals, or stay in a higher class ward.Example, a patient stayed in a A1 ward, in a private hospital. The total bill incurred was $10,000.Within the selected "as charged" plan, there is a pro-ration factor of 65% for private hospital, a deductible amount of $3,000, and a co-insurance component of 10%.The amount of bill to be covered by the "as charged" plan is only $3,150.The rider will cover the deductible $3,000 + co-insurance $350. That's $3,350.There is an outstanding amount of $3,500 to be paid by the patient.Depending on the no. of days stay, this amount might be paid through Medisave (at the point of final billing).Posted by: paufurhs at Sun Nov 04 10:59:52 SGT 2007You don't need to. The few private insurer like NTUC income, Aviva provide shield plans that cover your hospital bills on the "as charged" basis, meaning the whole claimable bills will be paid by insurers except the $3K deductible and 10% co-insurance of the balance. Best part is the premium can be paid using your CPF Medisave. On top you can buy a rider using cash to cover both the deductible and co-insurance portion. This can make the shield plan comparable to a private H & S plan costing thousand of dollars which is comprehensive and pay the first dollar. You dun incur a single cent when kena hospital stay and treatment.Posted by: lee_kum_wah at Sun Nov 04 08:26:44 SGT 2007As far as I know, there is a cap to how much the insurancewill pay for a single illness of an insured person. Can one take double insurance so that each insurance company can help pay $20000 of the $60000 bill?Posted by: zxcv0088 at Sun Nov 04 06:12:10 SGT 2007

Even though the PM himself was cured of his third stage cancer thanks in part to Traditional Chinese Medicine, PAP is not about to bring this alternative medical science into our hospitals in a big way, never mind what they may yet be announcing.

This is because such a alternative treatment will only compromise the lucrativeness arising out of the current PAP-Western medical collaboration.

So long as these elites are comfortable why bother about the fate and suffering of ordinary Singaporeans?

It's survival of the fittest, don't we remember what the MM's life philosophy is all about? People have to suffer because they are weak, while he and his elites are strong. See?

It is not about looking after a nation. It is all pure economics, Singapore Inc., as PAP called it.

I think the total bill for 1 month is 41K including 4K in non subsidized item (chemo etc). For a C class (assume 80% subsidy), the payable bill should be (41-4)*0.2+4= 11.4k. I believe the bulk of the fee is for the surgery (maybe about half, around 20k, not sure surgery in which table) another 30% probably ICU ward fee (around 300/day). The amount payable by Medisave is at most 7.4k because 4k cash is for chemo. This is based on what i know of hospital prices 5 years back, but i think should be the ball park.

Unfortunately buying insurance, especially Medishield, will not solve the problem for the patient's father. Cancer is specifically excluded from Medishield as catastrophic diseases. That is why there is a market for private insurance, but don't confuse insurance with charity. You either get more exclusions or pay big premium.

The article wasn't very clear if $41K is subsidize or not. But it said the father's medisave of $30K is exhausted so I take it that $41K was the bill after subsidy. Anyway, $100K bill (unsubsidised) is not uncommon.

Cancer is specifically excluded from medishield as a catastrophic illness? Really? Any reference for this? Any insurance that doesn't cover cancer is an umbrella with a big hole.

Think you are looking on the down side and not the upside to this. Just think of the money that you are saving in taxes. I was making $40,000/yr in Canada and 1/3 of that was going to the gov't to cover the income tax, health care, pension fund and all those other things that the gov't wasted my money on. In return, I got free health care (hernia operation was totally free, plus I received a 90% of my pay cheque because I was unable to work), free secondary school education, though had to take out a $40,000 student loan to cover my 4 year BA degree and no ERP/tolls on our road ways.

Here in Singapore, you pay the lowest taxes, but have to pay for every single thing that you use.

Honestly, would the average Singaporean actually accept having a 1/3 tax on their pay for the chance at free health care and road service? or would the majority then either figure if they are being taxed on it they are going to go into the hospital for everything from a hangnail to cancer, bogging down the health care system to such a degree that the island of Singapore will be like Canada where you have to wait 3 months for a hernia operation, or possibly 6-10 months for a kidney transplant. Would Singaporeans perhaps complain saying "why am I paying for road upkeep when I dont own a car?" or "why am I paying for a medical care when I have never been sick?" If people are not willing to put into a community pot for pension plan (I recall some people are saying if they put money into CPF, they want it all back and not just an average calculated sum), why would they put it into other things?

Perhaps the PAP have got it right and know the people that they are governing. If you disagree, perhaps vote them out in the next election. You get what you vote in.

How dare you even compare your inferior unprofitable Canadian system with the one we have in Singapore?!

We beat you guys in every aspect - our subsidised treatment have long waiting times compared with the free treatment.

You're right nothing is free someone gotta pay. Just like our defense spending and buildup of fantastic reserves - someone has to pay.

My posting is not about Singapore's current medical system which most Singaporeans have grown to accept & love but the future changes such as higher cost (=profits), reduced subsidy, means testing, longer waiting times for subsidised care ...etc. It is the future that we look forward to...

When health insurance comes into the picture the result is healthcare cost will go through the roof. This has been the case in the Western countries and yet we are following their bad system that failed to provide basic healthcare for the majority of citizens in those countries because they could not afford health insurance.

But in the case of welfare support, the Singapore Government says we should not follow the western countries because it is a bad system. The difference basically is that the welfare system will bankrupt the Government while the healthcare system will bankrupt its citizens.

So, where it benefits the Government they will implement it pouring out all the arguments in favour of what they wanted to do. More will come to grief when means testing comes into the picture. Dying is not a problem, being sick is.

Not all of it goes into the pension fund. For instance, the last pay stub that I received said I made $2,227 for 121 hours worked (I know, low wage but what do you expect from a cook job?), of which

$104.47 was taken away for Canada Pension Plan

$480.31 for Income Tax$40.70 for Unemployment Insurance (If I lose my job due to 'retrenchment' they pay me 75% of my last salary til I find work and will even pay for my courses to retrain me in another area)

So, while Singaporeans lose 1/3 of their pay to the CPF, that is money that the gov't has squirreled away for you. I only had $104 taken away for my pension plan whereas $400 is taken for that waste of money called health care, unemployment insurance, city infrastructure repairs, welfare and all those other glorious things that the Canadian Gov't does for us.

From what I understand, someone making around $100,000/year only gets taxed something like $4,000. In my books, and from what I hear from the friends in Singapore I talk to, that is really cheap and Singaporeans are taxed little....CPFed horribly, but taxed little.